Dr. Dorry Segev is a junior faculty member in Transplant Surgery at the Johns Hopkins School of Medicine, where he received all of his medical education and training. He is also completed all requirements for an MHS in Biostatistics and is pursuing a PhD in Clinical Investigation from the Johns Hopkins Bloomberg School of Public Health. Dr. Segev's previous work has focused on kidney allocation and outcomes after solid organ transplantation. With the support of this Beeson Career Development Award, Dr. Segev seeks to better understand access to transplantation and clinical decision making in older patients with end-stage renal disease. This award will provide Dr. Segev with the resources he needs to become an independent investigator and leader in transplant geriatrics. Building on research experience and skills attained through the NIH Clinical Research Scholars Program and the American Geriatrics Society's Jahnigen Scholars Award, Dr. Segev aims to assess disparities in access to transplantation in elderly patients. First, in an effort to better identify which older patients will benefit from a kidney transplant, he will build prediction models based on multi-level national cohort data collected through the United States Renal Data System (USRDS) and the United Network for Organ Sharing (UNOS). He will also compare patterns of referral for transplantation for younger patients who are likely to do well after a transplant with patterns of referral for older patients who are likely to do well. Then, he will dissect out the patient- and provider-level factors that might affect access to transplantation in older patients. He will do this through multiple focus groups which will then inform quantitative surveys of dialysis patients as well as nephrologists. In addition to experience in the conduct of these studies, Dr. Segev will enhance his research knowledge and skills through formal coursework including a Gerontology Certificate, directed research mentorship by a team of experienced geriatricians and epidemiologists, and immersion in the multidisciplinary environments of the Welch Center, the Center on Aging and Health, and the Comprehensive Transplant Center. RELEVANCE: Older dialysis patients have very limited access to kidney transplantation compared with their younger counterparts. Barriers to access can occur as a result of patient reluctance or a lack of provider referral, and a better understanding of these barriers will assist in the development of educational initiatives to improve access to transplantation in these elderly patients.